What to know about hepatitis C and heart transplants

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Recent research suggests transplant surgeries using organs from people with hepatitis C could be a safe option, helping alleviate the organ shortage in the U.S.

Wait times for heart transplantation have significantly increased in recent decades. Research indicates that those who wait for the longest on the waitlist have the greatest chance of transplant failure.

People may reduce their time on the waiting list if they are willing to receive an organ donation from someone who has had hepatitis C. Most cases of hepatitis C are curable with direct-acting antiviral treatments, or DAAs. These drugs can cure most cases of hepatitis C within 12–24 weeks.

Research indicates that survival rates at 1 year after heart transplant surgery are about 90% regardless of whether a recipient has a heart from a donor with or without hepatitis C. Rates of organ rejection, stroke, and the need for kidney dialysis following heart transplant surgery are also similar.

Organ recipients who develop donor-derived hepatitis C can most likely clear the infection with antiviral treatments.

Doctors consider people with liver disease, such as hepatitis C, a high risk for heart surgery. They tend to experience more complications after surgery, require longer stays in the hospital and have increased mortality than people without liver disease.

Without treatment, hepatitis C can cause scarring to the liver, known as cirrhosis.

The combination of cirrhosis from hepatitis C and heart surgery may prevent the liver from functioning properly, resulting in liver failure. Damage to the liver also prevents it from effectively processing anesthesia medications during surgery.

Healthcare professionals carefully weigh a person’s risks versus benefits before recommending surgery. Factors they consider may include:

• type of surgery
• length of surgery
• need for surgery
• the severity of liver disease
• type of anesthesia
• stability of blood pressure

Doctors may consider a combined heart and liver transplant for people with severe liver damage resulting in liver failure.

Healthcare professionals predict surgical risk according to the severity of a person’s liver disease.

A doctor may determine a person with chronic hepatitis C and relatively good liver function is suitable for surgery. However, depending on the recipient’s other health conditions and clinical needs, they may advise those with acute hepatitis or severe cirrhosis against heart transplant surgery.

Some individuals with hepatitis C should not have heart transplant surgery, including people over 70 years old and those with the following conditions or lifestyle habits:

• invasive systemic disease
• severe infections
• HIV
• cigarette smokers
• substance misuse
• dementia
• major psychiatric illness
• certain forms of cancer
• severe high blood pressure
• acute pulmonary thromboembolism
• obesity
• renal dysfunction
• diabetes with end-organ damage
• peptic ulcer disease
• cirrhosis

Doctors may recommend heart transplant surgery for people with severe heart failure who do not respond to medication treatment. They must also receive a diagnosis of end-stage heart disease.

Additionally, heart transplant candidates should be:

• under 69 years old
• at risk for mortality within 1 year if they do not undergo surgery

Candidates for heart transplant surgery must then undergo a thorough evaluation to determine:

• the stage of heart disease
• a pre-operative and post-operative care plan
• issues that may impact their candidacy for heart transplant surgery

Healthcare professionals may also conduct:

• blood tests
• urine tests
• EKGs
• chest X-rays
• echocardiograms
• CT scans
• cardiac stress tests
• MRIs
• ultrasounds
• biopsies
• catheterizations
• pulmonary function tests
• endoscopies
• psychosocial evaluations

Candidates for heart transplant surgery undergo a thorough evaluation process. They must also get vaccines that minimize their likelihood of infections affecting the new heart.

After approval for heart transplant surgery, a person will join the United Network for Organ Sharing list. A person is selected from the list to receive a new heart based on the severity of their condition, blood type, and body size.

If selected, a person must go to the predetermined hospital as soon as possible to prep for surgery. Most heart transplant surgeries occur within 4 hours after the removal of the heart from the donor.

Before undergoing heart transplant surgery, a person will receive the following:

• an intravenous (IV) line in their hand or arm
• intravenous fluids
• catheters in their neck, wrist, underarm, and groin to monitor heart status and blood pressure
• a bladder catheter for draining urine
• a tube that links from the nose or mouth to the stomach that empties stomach fluids
• general anesthesia to induce a deep sleep
• a breathing tube connected between their mouth and lungs

To perform the heart transplant surgery, a surgeon may perform the following steps:

• Make a vertical incision in the center of the chest.
• Cut the person’s sternum and separate the halves to reach the heart.
• Insert tubes into the chest, allowing blood to pump through the body through a heart-lung machine.
• Remove the failing heart.
• Implant the heart from the donor.
• Connect blood vessels to the new heart.
• Redirect the blood passing through the bypass machine back into the heart.
• Remove tubes from the heart-lung machine.
• Administer a shock to the heart to restart the heartbeat.
• Evaluate the new heart to see how it is working.
• Attach wires for pacing into the new heart.
• Rejoin the sternum.
• Sew the skin together that covers the sternum with sutures or surgical staples.
• Place tubes into the chest that drain blood and other fluids away from the heart.
• Apply a sterile bandage or dressing.

Following heart transplant surgery, there is a risk that the body may reject the new heart. Sometimes the body’s immune system recognizes that the new heart’s cells are unlike the rest of the cells in the body and attempts to get rid of them.

A person takes immunosuppression medications for the rest of their life to prevent their body from rejecting the new heart. Some of these medications can have serious side effects, so a doctor needs to find those that work best for the individual. Antirejection medications may also make people susceptible to infections, such as respiratory viruses.

Heart transplant patients usually have regular right heart biopsies following the surgery. At first, the biopsies take place weekly and then gradually extend to longer intervals.

Additionally, doctors monitor heart transplant patients using:

• blood tests
• vital signs monitoring
• echocardiograms
• chest X-rays
• cardiac catheterization

After a heart transplant, people should avoid smoking, using other tobacco products, and drinking alcohol. Tobacco products can damage the heart, and alcoholic beverages can interfere with antirejection medications.

Research indicates that around 90% of individuals who have had heart transplants achieved at least 1-year of survival following surgery.

The survival rate was similar regardless of receiving the heart from a person with or without hepatitis C. However, more research is required to get a clearer picture of long-term health outcomes.

Hepatitis C is a liver disease that a person may develop after contracting the hepatitis C virus. The severity of the condition varies.

Those with hepatitis C are usually not the best candidates for heart transplant surgery. However, it is possible for some.

Individuals with hepatitis C can be organ donors. Recent studies show that people who receive heart donations from those who had hepatitis C achieve survival rates similar to those who received hearts from people without hepatitis C.